Postoperative Behavioural, Cognitive, And Psychological Changes Following General Versus Regional Anaesthesia: A Narrative Review

Postoperative behavioural, cognitive, and psychological changes represent an important spectrum of recovery-related complications after surgery and anaesthesia. This narrative review examines the available evidence comparing general anaesthesia with regional anaesthesia, with particular attention to postoperative delirium, delayed neurocognitive recovery, postoperative neurocognitive disorder, behavioural changes, and psychological outcomes. The available literature suggests that these outcomes are multifactorial and are influenced by patient vulnerability, surgical stress, inflammation, pain, sleep disturbance, medications, haemodynamic and respiratory changes, and anaesthetic exposure. Comparative evidence has not consistently demonstrated superiority of regional over general anaesthesia for prevention of postoperative delirium or cognitive dysfunction. Regional techniques may reduce exposure to general anaesthetic agents and postoperative opioid requirements in selected settings, but sedation and other perioperative factors can confound comparisons. Preoperative risk assessment, appropriate anaesthetic depth, effective analgesia, physiological optimisation, and multimodal postoperative care remain important components of prevention. Further well-designed studies using standardised definitions, baseline cognitive assessment, validated outcome measures, and adequate follow-up are needed.